HealthHelp relaunches precertification program

HealthHelp, a radiology utilization management company, has relaunched its imaging precertification program in response to calls to curb rising imaging costs.

The Houston-based company had offered precertification in the past. But HealthHelp discontinued precertification when its RadConsult ordering-support program proved more popular with its health insurer clients.

Health plans at the time were moving away from precertification programs that allowed a consult with a radiologist who recommended the best test and cited the peer-reviewed literature but never denied an exam, said Cherrill Farnsworth, HealthHelp's chief executive officer.

HealthHelp cultivated a reputation as a radiologist-friendly company by emphasizing physician education and volunteer curbs to reduce inappropriate imaging referrals. That approach lost its luster as medical imaging utilization skyrocketed. According to the American College of Radiology, diagnostic imaging is the fastest growing physician service in the U.S.

HealthHelp introduced its new precertification program in January amidst insurer plan demands for strategies with sharper teeth, Farnsworth said.

Unlike its previous precertification program, the new program will deny inappropriate procedures. It includes peer-reviewed literature that can be sent to physicians to help them understand the decision to deny a procedure, Farnsworth said.

The company gives out the evidence-based rules at the initiation of the program. All ordering physicians participating in the program receive the Medical Imaging Consultant in its text or e-text form.

One lesson HealthHelp learned from its previous effort is that peer-reviewed literature explaining the decision behind denying a procedure is imperative in providing long-term savings, Farnsworth said. By offering education on the appropriateness of imaging exams, the program can become a preventive tool, teaching physicians and helping them to avoid unnecessary ordering in the future.

Old precertification methods that did not offer that type of education encouraged physicians to rely on buzz words they knew would get an exam approved.

"One of the biggest issues that physicians cope with in a precertification program is not knowing the rules and having to guess the words to say to get the test they want, and then memorizing those words. This doesn't improve care. It just teaches doctors to cheat, which they dislike," she said.

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